Clinical usefulness of the baby vision test in young children and its correlation with the Snellen chart

AIM:To investigate the efficacy of a new visual acuity(VA)screening method,the baby vision test for young children.METHODS:A total 105 eyes of 65 children aged 2-8y were included in the study.Acuity testing was conducted using a standardized recognition acuity chart(Snellen visual chart:at 3 m)and the baby vision model assessment.The baby vision device includes a screen,a near infrared camera and a computer.Children were seated at a measured distance of 33-40 cm from a display for testing.VA was estimated according to the highest resolution the children could follow.Decimal VA data were converted to logarithm of the minimum angle of resolution(logMAR)for statistical analysis.The VA results for each child were recorded and analyzed for consistency.RESULTS:The mean VA measured using the Snellen visual chart was 0.62±0.32,and that assessed using the baby vision test was 0.66±0.27.The 95%limit of agreement was-0.609 to 0.695,with 95.2%(100/105)plots within the 95%limits of agreement.VA values of the baby vision test were significantly correlated with those of the Snellen chart(R=0.274,P=0.005).CONCLUSION:The baby vision test can be used as a relatively reliable method for estimating VA in young children.This new acuity assessment might be a valid predictor of optotype-measured acuity later in preverbal children.

Non-contact wide-field viewing system-assisted scleral buckling surgery for retinal detachment in silicone oilfilled eyes

AIM:To evaluate scleral buckling(SB)surgery using a noncontact wide-field viewing system and 23-gauge intraocular illumination for the treatment of rhegmatogenous retinal detachment in silicone oil(SO)-filled eyes.METHODS:Totally 9 patients(9 eyes)with retinal detachment in SO-filled eyes were retrospectively analyzed.All patients underwent non-contact wide-field viewing system-assisted buckling surgery with 23-gauge intraocular illumination.SO was removed at an appropriate time based on recovery.The patients were followed up for at least 3mo after SO removal.Retinal reattachment,complications,visual acuity and intraocular pressure(IOP)before and after surgery were observed.RESULTS:Patients were followed up for a mean of 8.22mo(3-22mo)after SO removal.All patients had retinal reattachment.At the final follow-up,visual acuity showed improvement for 8 patients,and no change for 1 patient.The IOP was high in 3 patients before surgery,but it stabilized after treatment;it was not affected in the other patients.None of the patients had infections,hemorrhage,anterior ischemia,or any other complication.CONCLUSION:This new non-contact wide-field viewing system-assisted SB surgery with 23-gauge intraocular illumination is effective and safe for retinal detachment in SO-filled eyes.

CD3ε of a pan T cell marker involved in mouse Aspergillus fumigatus keratitis

AIM:To explore whether CD3ε is involved in the adaptive immunity of Aspergillus fumigatus(A.fumigatus)keratitis in mice and the role of innate and adaptive immunity in it.METHODS:Mice models of A.fumigatus keratitis were established by intra-stromal injection and corneal epithelial scratching.Subconjunctival injections of natamycin,wedelolactone,LOX-1 inhibitor(poly I)or Dectin-1 inhibitor(laminarin)were used to treat mice with A.fumigatus keratitis.Mice were pretreated by intraperitoneal injection of anti-mouse CD3ε.We observed the corneal infection of mice under the slit lamp microscope and made a clinical score.The protein expression of CD3ε and interleukin-10(IL-10)was determined by Western blotting.RESULTS:With the disease progresses,the degree of corneal opacity and edema augmented.In the intrastromal injection models,CD3εprotein expression began to increase significantly on the 2^(nd) day.However,in the scraping epithelial method models,CD3ε only began to increase on the 3^(rd) day.After natamycin treatment,the degree of corneal inflammation in mice was significantly attenuated on the 3^(rd) day.After wedelolactone treatment,the severity of keratitis worsened.And the amount of CD3ε protein was also reduced,compared with the control group.By inhibiting LOX-1 and Dectin-1,there was no significant difference in CD3ε production compared with the control group.After inhibiting CD3ε,corneal ulcer area and clinical score increased,and IL-10 expression was downregulated.CONCLUSION:As a pan T cell marker,CD3ε participate in the adaptive immunity of A.fumigatus keratitis in mice.In our mice models,the corneas will enter the adaptive immune stage faster.By regulating IL-10,CD3ε exerts antiinflammatory and repairs effects in the adaptive immune stage.

Topographic distribution features of the choroidal and retinal nerve fiber layer thickness in Wenzhou schoolaged children

AIM:To explore the topographic distribution features of choroidal thickness(CT)and retinal nerve fiber layer thickness(RNFLT),and determine the relationship between CT and ocular parameters in school-aged children.METHODS:The healthy school-aged children with low myopia or emmetropia in Wenzhou were recruited for this cross-sectional study.With high-density optical coherence tomography(HD-OCT)combined with MATLAB software,the CT and RNFLT values in the macular area were measured at different locations and compared.Statistical analyses were performed to evaluate the correlation between CT and ophthalmic parameters,such as spherical equivalent(SE)and the axial length(AL).RESULTS:A total of 279 school-aged children with 8.00±1.35 years of mean age(range,6-10 y)were included.The mean AL was 23.66±0.86 mm.The mean CT in CT-C(264.31±48.93μm)was thicker than that in CT-N1(249.54±50.52μm),and the average CT in the parafoveal region was also thicker than that in CT-N2(235.65±50.63μm).The subfoveal CT also varied substantially across refractive errors(P<0.001),and those with myopia(250.59±47.01μm)exhibited a thinner choroid compared with those with emmetropia(278.74±48.06μm).CT positively correlated with AL(y=11.12 x-4.15;R^2=0.18),and positively correlated with SE(y=90.07 x+17.916;R^2=14.2).The average RNFLT was thickest in the peripapillary region(236.35±19.03μm),the mean RNFLT-S(131.10±15.16μm)was thicker than the RNFLT-I(128.20±16.59μm),and the mean RNFLT-T(76.54±11.99μm)was thicker than the RNFLT-N(64.28±8.55μm).The variations in the RNFLT between quadrants did differ between those with myopia and emmetropia(P<0.05).CONCLUSION:We establish demographic information for the choroid and RNFLT.These findings provide information that should be considered in future analyses of the CT and RNFLT in OCT studies in school-aged children.

Elementary school comprehensive intervention and myopia development:the Wenzhou Epidemiology of Refraction Error Study

AIM:To investigate the effects of school-basedcomprehensive intervention on myopia development inelementary school children.METHODS:As a part of the Wenzhou Epidemiologyof Refraction Error Study,there were 1524 participatingelementary students(730 girls,47.9%)in grades 1 to3 from three campuses of one school,aged 7.3±0.9y,who were examined twice every year for a 2.5y follow upperiod.Comprehensive intervention and other reminderswere given at school every semester for the interventiongroup.The control group did not receive comprehensiveintervention and did not have reminders of it.RESULTS:There were 651 students in the interventiongroup[mean age 7.3±0.9y;294(45.2%)girls]and 737students in the control group[mean age 7.2±0.9y;346(46.9%)girls].Overall mean myopia progression duringthe 2.5y follow-up was-0.49±1.04 diopters(D)in theintervention group and-0.65±1.08 D in the control group(P=0.004).The majority that not get myopia at baselinespherical equivalent(SE≤-1.0 D).Their mean myopiaprogression during the 2.5y follow-up was-0.37±0.89 Din the intervention group and-0.51±0.93 D in the controlgroup(27.5%reduction,P=0.009);Overall,mean axiallength elongation was less in the intervention group(0.56±0.32 mm)than in the control group(0.61±0.38 mm,10.5%reduction,P=0.009).The percentage of close reading distance(<30 cm)in the intervention group was less than in the control group(73.4%vs 76.2%,P<0.001),the percentage of everyday perform eye exercises in the intervention group was more than in the control group(27.8%vs 20.7%,P<0.001)30mo later.CONCLUSION:The comprehensive intervention program at elementary school has a significant alleviating effect on myopia progression for children during the 2.5y follow-up,especially for those non-myopia at baseline.

Effect of a novel tyrosine kinase inhibitor nintedanib on bFGF and VEGF concentrations in a rabbit retinal vein occlusion model

AIM:To evaluate whether a novel tyrosine kinase inhibitor nintedanib could inhibit basic fibroblast growth factor(bFGF)and vascular endothelial growth factor(VEGF)simultaneously for retinal vascular disease in vivo.METHODS:After a laser induced rabbit retinal vein occlusion(RVO)model was made,0.5 mg of nintedanib was injected intravitreally in the left eye on the third day while the right eye was as a control.Intracameral samples were taken on the day before laser treatment and days 1,3,7,14,21,and 28 after treatment.Enzyme-linked immunosorbent assay(ELISA)was used to test the bFGF and VEGF-A concentrations in the aqueous humor.RESULTS:Both bFGF and VEGF-A rose significantly on the third day after laser treatment in both eyes.In the control eye the bFGF concentration peaked on the 14th day while the VEGF-A concentration dropped rapidly soon after the third day.After nintadanib injection in the study eye,both bFGF and VEGF-A showed a significant reduction on the 4th day(7th day after laser treatment)when compared to the control eye,and kept on low level in the following several weeks.CONCLUSION:Intravitreal injection of nintedanib can inhibit the expression of bFGF and VEGF in the process of RVO model to a certain extent,which is expected to become a new method for the treatment of retinal vascular diseases or fibrotic diseases.

Evaluation of optic nerve head vessels density changes after phacoemulsification cataract surgery using optical coherence tomography angiography

·AIM:To evaluate optic nerve head(ONH)vessel density(VD)changes after cataract surgery using optical coherence tomography angiography(OCTA).·METHODS:This was a prospective observational study.Thirty-four eyes with mild/moderate cataracts were included.ONH scans were obtained before and 3mo after cataract surgery using OCTA.Radial peripapillary capillary(RPC)density,all VD,large VD and retinal nerve fiber layer thickness(RNFLT)in total disc,inside disc,and different peripapillary sectors were assessed and analyzed.Image quality score(QS),fundus photography grading and bestcorrected visual acuity(BCVA)were also collected,and correlation analyses were performed between VD change and these parameters.·RESULTS:Compared with baseline,both RPC and all VD increased in inside disc area 3mo postoperatively(from 47.5%±5.3%to 50.2%±3.7%,and from 57.87%±4.30%to 60.47%±3.10%,all P<0.001),but no differences were observed in peripapillary area.However,large VD increased from 5.63%±0.77%to 6.47%±0.72%in peripapillary ONH region(P<0.001).RPC decreased in inferior and superior peripapillary ONH parts(P=0.019,<0.001 respectively).There were obvious negative correlations between RPC change and large VD change in inside disc,superior-hemi,and inferior-hemi(r=-0.419,-0.370,and-0.439,P=0.017,0.044,and 0.015,respectively).No correlations were found between VD change and other parameters including QS change,fundus photography grading,postoperative BCVA,and postoperative peripapillary RNFLT.·CONCLUSION:RPC density and all VD in the inside disc ONH region increase 3mo after surgery in patients with mild to moderate cataract.No obvious VD changes are found in peripapillary area postoperatively.

In vitro protective effect of recombinant prominin-1 combined with microRNA-29b on N-methyl-D-aspartateinduced excitotoxicity in retinal ganglion cells

AIM:To determine the in vitro protective effect of recombinant prominin-1(Prominin-1)+microRNA-29b(P1M29)on N-methyl-D-aspartate(NMDA)-induced excitotoxicity in retinal ganglion cells(RGCs).METHODS:RGC-5 cells were cultured,and NMDAinduced excitotoxicity at the range of 100–800μmol/L was assessed using the MTT assay.NMDA(800μmol/L)was selected as the appropriate concentration for preparing the cell model.To evaluate the protective effect of P1M29 on the cell model,Prominin-1 was added at the concentration of 1–6 ng/mL for 48h,and the cell survival was investigated with/without microRNA-29b.After obtaining the appropriate concentration and time of P1M29 at 48h,real-time polymerase chain reaction(PCR)was utilized to detect the relative mRNA expression of vascular endothelial growth factor(VEGF)and transforming growth factor(TGF)-β2.Western blot detection was applied to measure the phosphorylation levels of protein kinase B(AKT)and extracellular regulated protein kinases(ERK)in RGC-5 cells after treatment with Prominin-1.Apoptosis study of the cell model was conducted by flow cytometry for estimating the anti-apoptotic effect of P1M29.Immunofluorescence analysis was used to analyze the expression levels of VEGF and TGF-β2.RESULTS:MTT cytotoxicity assays demonstrated that P1M29 group had significantly higher cell survival rate than Prominin-1 group(P<0.05).Real-time PCR data indicated that the expression levels of VEGF were significantly increased in both Prominin-1 and P1M29 groups compared NMDA and microRNA-29b group(P<0.05),while TGF-β2 were significantly decreased in both microRNA-29b and P1M29 groups compared NMDA and Prominin-1 group(P<0.05).Western blot results showed that both Prominin-1 and P1M29 groups significantly increased the phosphorylation levels of AKT and ERK compared to NMDA and microRNA-29b groups(P<0.05).Flow cytometry analysis revealed that P1M29 could prevent RGC-5 cell apoptosis in the early stage of apoptosis,while immunofluorescence results showed that P1M29 group had higher expression of VEGF and lower expression of TGF-β2 with a stronger green fluorescence than NMDA group.CONCLUSION:Prominin-1 combined with microRNA-29b can provide a suitable therapeutic option for ameliorating NMDA-induced excitotoxicity in RGC-5 cells.

Optical coherence tomography angiography characteristics of exudative and non-exudative treatmentnaive pachychoroid neovasculopathy

AIM:To describe the optical coherence tomography angiography(OCTA)characteristics of exudative and nonexudative treatment-naïve pachychoroid neovasculopathy(PNV).METHODS:Thirty-five patients with exudative treatmentnaïve PNV and 13 with non-exudative treatment-naïve PNV between March 2020 and December 2021 were included.All patients underwent ophthalmologic examination,including fluorescein angiography(FA),indocyanine green angiography(ICGA),spectral-domain OCT,and OCTA.The clinical data of the patients were retrospectively analyzed.RESULTS:The study included 51 eyes from 46 patients,of whom 33(71.7%)were male.The central macular thickness(CMT)in the exudative PNV group was significantly higher than that in the non-exudative PNV group(383.97±132.16μm vs 213.13±51.63μm;P<0.001).The maximum height of flat irregular pigment epithelial detachments(FIPED)was 45.40±11.86μm in the non-exudative PNV group,significantly lower than the 71.58±20.91μm(P<0.001)in the exudative PNV group.The area of PNV of the non-exudative PNV group was,significantly larger than that of the exudative PNV group(1.06±0.84 mm2 vs 0.63±0.80 mm2,P=0.016).There was a significant difference in PNV morphology between the two groups(P<0.001).Multivariate logistic regression analysis found that the maximum height of FIPED(OR=1.156,95%CI:1.019-1.312;P=0.024)and microvascular branches(OR=69.412,95%CI:3.538-1361.844;P=0.005)were independent predictors of PNV activity.CONCLUSION:The OCTA imaging finds that there are significant differences in CMT,maximum height of FIPED,PNV area,and morphology of exudative PNV and non-exudative PNV groups.OCTA can accurately identify the clinical and imaging features of exudative and nonexudative treatment-naïve PNV,and distinguish PNV activity.

Retinal vascular morphological characteristics in diabetic retinopathy: an artificial intelligence study using a transfer learning system to analyze ultra-wide field images

AIM:To investigate the morphological characteristics of retinal vessels in patients with different severity of diabetic retinopathy(DR)and in patients with or without diabetic macular edema(DME).METHODS:The 239 eyes of DR patients and 100 eyes of healthy individuals were recruited for the study.The severity of DR patients was graded as mild,moderate and severe non-proliferative diabetic retinopathy(NPDR)according to the international clinical diabetic retinopathy(ICDR)disease severity scale classification,and retinal vascular morphology was quantitatively analyzed in ultra-wide field images using RU-net and transfer learning methods.The presence of DME was determined by optical coherence tomography(OCT),and differences in vascular morphological characteristics were compared between patients with and without DME.RESULTS:Retinal vessel segmentation using RU-net and transfer learning system had an accuracy of 99%and a Dice metric of 0.76.Compared with the healthy group,the DR group had smaller vessel angles(33.68±3.01 vs 37.78±1.60),smaller fractal dimension(Df)values(1.33±0.05 vs 1.41±0.03),less vessel density(1.12±0.44 vs 2.09±0.36)and fewer vascular branches(206.1±88.8 vs 396.5±91.3),all P<0.001.As the severity of DR increased,Df values decreased,P=0.031.No significant difference between the DME and non-DME groups were observed in vascular morphological characteristics.CONCLUSION:In this study,an artificial intelligence retinal vessel segmentation system is used with 99%accuracy,thus providing with relatively satisfactory performance in the evaluation of quantitative vascular morphology.DR patients have a tendency of vascular occlusion and dropout.The presence of DME does not compromise the integral retinal vascular pattern.

Prognostic factors of trans-ethmosphenoid optic canal decompression for indirect traumatic optic neuropathy

AIM： To investigate a possible correlation between visual acuity（VA） prognosis and the presence at baseline of various orbital and ocular signs in patients affected by indirect traumatic optic neuropathy（ITON）. METHODS： From July 1 st, 2012 to July 1 st, 2015, 224 adults diagnosed with ITON who underwent endoscopic transethmosphenoid optic canal decompression（ETOCD） were reviewed. Visual outcome before and after treatment were taken into comparison. RESULTS： Accompanied older in age, longer time to medical treatment and existence of optic canal fracture（OCF） were the independent predictors for poor postoperative VA and lower improvement degree of visual acuity（IDVA）, while worse preoperative VA was predictive factor for poor postoperative VA only. Mean value of IDVA in patients with OCF was 0.19±0.30. Mean value of IDVA in patients without OCF was 0.29±0.35. IDVA in cases without OCF was significant higher than those with OCF（t=2.272, P〈0.05）. CONCLUSION： Patients suffered from ITON without OCF before ETOCD have better surgical outcome than those with OCF. Older in age, longer time to medical treatment and existence of OCF are independent factors for poor VA prognosis and lower IDVA. Preoperative VA is independent factor for VA prognosis only.

Short term effect of choroid thickness in the horizontal meridian detected by spectral domain optical coherence tomography in myopic children after orthokeratology

AIM： To investigate choroidal thickness changes in the horizontal meridian after orthokeratology. METHODS： This is a prospective cross-sectional observed study. Subjects （n=30; 11.3±1.7y） with low-to-moderate myopia （-1.0 to -6.0 diopters）, wore orthokeratology （Ortho-K） lenses for 3mo. Before and after Ortho-K, OCT scans were made through the fovea in the horizontal meridian. Choroid thickness around the fovea was acquired by custom software. The analyzed regions along the horizontal meridian were divided into 7 equal zones. Ocular parameters were measured by Lenstar LS 900 non-contact biometry. RESULTS： Only the right eye ocular parameters were analyzed in this study. Before Ortho-K, choroidal thickness along the horizontal meridian was 273.7±31.8 μm in the temporal zone, 253.1±38.6 μm in the macula zone, and 194.8±52.2 μm in the nasal zone. After Ortho-K, the choroid was thicker in each horizontal zone （P〈0.05）. The increased thickness was greatest in the temporal zone （13.5±22.5 μm） and least in the nasal zone （8.4±14.2 μm）. The axial length （AL） increased 0.02 mm （P〉0.05）. The choroid thickness change in each horizontal zone was negatively correlated with AL （r, -0.3 to -0.4; P〈0.05） except one of the nasal zones. CONCLUSION： In myopic children, the thickness of the choroid is greatest in the temporal zone and thinnest in the nasal zone. After nightly Ortho-K for 3mo, the thickness increase along the horizontal meridian. The choroid thickness changes are negatively correlated with the change of AL.

Comparison of isolated-check visual evoked potential and standard automated perimetry in early glaucoma and high-risk ocular hypertension

AIM：To compare the diagnostic performance of isolatedcheck visual evoked potential（ic VEP） and standard automated perimetry（SAP）,for evaluating the application values of ic VEP in the detection of early glaucoma.METHODS：Totally 144 subjects（288 eyes） were enrolled in this study.ic VEP testing was performed with the Neucodia visual electrophysiological diagnostic system.A 15% positive-contrast（bright） condition pattern was used in this device to differentiate between glaucoma patients and healthy control subjects.Signal-to-noise ratios（SNR） were derived based on a multivariate statistic.The eyes were judged as abnormal if the test yielded an SNR≤1.SAP testing was performed with the Humphrey Field Analyzer II.The visual fields were deemed as abnormality if the glaucoma hemifield test results outside normal limits;or the pattern standard deviation with P〈0.05;or the cluster of three or more non-edge points on the pattern deviation plot in a single hemifield with P〈0.05,one of which must have a P〈0.01.Disc photographs were graded as either glaucomatous optic neuropathy or normal by two experts who were masked to all other patient information.Moorfields regression analysis（MRA） used as a separate diagnostic classification was performed by Heidelberg retina tomograph（HRT）.RESULTS：When the disc photograph grader was used as diagnostic standard,the sensitivity for SAP and ic VEP was 32.3% and 38.5% respectively and specificity was 82.3% and 77.8% respectively.When the MRA Classifier was used as the diagnostic standard,the sensitivity for SAP and ic VEP was 48.6% and 51.4% respectively and specificity was 84.1% and 78.0% respectively.When the combined structural assessment was used as the diagnostic standard,the sensitivity for SAP and ic VEP was 59.2%and 53.1% respectively and specificity was 84.2% and 84.6% respectivlely.There was no statistical significance between the sensitivity or specificity of SAP and ic VEP,regardless of which diagnostic standard was based on.CONCLUSION：The diagnostic performance of ic VEP is not better than that of SAP in the detection of early glaucoma.

Effect of intravitreal conbercept treatment before vitrectomy in proliferative diabetic retinopathy

AIM： To evaluate the safety and efficacy of intravitreal conbercept（IVC） injections as pretreatment for pars plana vitrectomy（PPV） in severe proliferative diabetic retinopathy（PDR）. METHODS： This was a retrospective chart review of all patients who underwent PPV for PDR from January 2014 to October 2016. Patients who underwent IVC injection before PPV were assigned to the IVC group; the others were assigned to the control group. The IVC was performed 3-7 d before surgery in the IVC group. All the eyes in the two groups were operated by the same doctor to complete the vitrectomy. Intraoperative complications and the changes in best-corrected visual acuity（BCVA） before and after surgery were compared between the two groups. RESULTS： A total of 68 eyes of 63 patients（22 eyes in the IVC group and 46 eyes in the control group） were examined. The risk of intraoperative bleeding was lower in the IVC group（2/22） than in the control group（25/46, P=0.000）. Furthermore, the use of endodiathermy was significantly lower in the IVC group（1/22） than in the control group（12/46, P=0.047）. The surgical time in the IVC group（112.64±34.52 min） was significantly shorter than in the control group（132.85±40.04 min, P〈0.05）. Compared to the BCVA before surgery, the mean BCVA was significantly improved after surgery for both groups（P〈0.05）. CONCLUSION： PPV is an effective treatment and can improve vision in patients with PDR. Preoperative intravitreal injection of conbercept could reduce the chances of intraoperative bleeding and the use of endodiathermy and shorten the operative time, which are beneficial in the management of PDR.

Endoscopic dacryocystorhinostomy with mucosal anastomosing in chronic dacryocystitis with three categories of ethmoid sinuses

AIM: To evaluate the outcome of endoscopic dacryocystorhinostomy(En-DCR) with mucosal anastomosis in chronic dacryocystitis patients, with various categories of ethmoid sinuses.METHODS: Between July 2015 and September 2019, 1439 adult patients, representing 1623 affected eyes, presented with chronic dacryocystitis and were scheduled for En-DCR. The categories of ethmoid sinuses were preoperatively determined, using computed tomographydacr yocystography(CT-DCG), and were classified as category 1(C1), category 2(C2), and category 3(C3). No sinuses anterior to the posterior lacrimal crest defined as C1. Sinuses found between the anterior edge of the lacrimal bone and the posterior lacrimal crest defined as C2. Sinuses found anterior to the lacrimal bone suture defined as C3. At the end of surgery, the dacryocyst and nasal mucosa were anastomosed in C1, and the dacryocyst mucosa and anterior ethmoid sinus were anastomosed in C2 and C3 ethmoid sinus patients. The surgical success rate and related complications, in patients with 3 categories of ethmoid cells, were monitored and documented.RESULTS: Postoperative data was obtained for 179 C1 affected eyes, 878 C2 affected eyes, and 432 C3 affected eyes. The overall success rate of En-DCR was 93.0%(1385/1489). Additionally, the success rates were comparable among the different ethmoid categories at 12mo post operation. We demonstrated that the major reason for surgical failure was intranasal ostial closure, due to granulation or scar tissue.CONCLUSION: En-DCR is a feasible and highly effective primary treatment for chronic dacryocystitis. To ensure surgical success, the surgery protocol must be designed in accordance with the category of ethmoid sinuses present in individual patient.

Characteristics of macular microvasculature before and after idiopathic macular hole surgery

AIM:To evaluate the macular microvasculature before and after surgery for idiopathic macular hole(MH)and the association of preoperative vascular parameters with postoperative recovery of visual acuity and configuration.METHODS:Twenty eyes from 20 patients with idiopathic MH were enrolled.Optical coherence tomography angiography(OCTA)images were obtained before,2 wk,1,and 3 mo after vitrectomy with internal limiting membrane peeling.Preoperative foveal avascular zone(FAZ)area and perimeter and regional vessel density(VD)in both layers were compared according to the 3-month best-corrected visual acuity(BCVA).RESULTS:The BCVA improved from 0.98±0.59(log MAR,Snellen 20/200)preoperatively to 0.30±0.25(Snellen 20/40)at 3 mo postoperatively.The preoperative deep VD was smaller and the FAZ perimeter was larger in the 3-month BCVA<20/32 group(all P<0.05).A significant reduction was observed in FAZ parameters and all VDs 2 wk postoperatively.Except for deep perifoveal VD,all VDs recovered only to their preoperative values.The postoperative FAZ parameters were lower during follow-up.Decreases in preoperative deep VDs were correlated with worse postoperative BCVA(Pearson’s r=-0.667 and-0.619,respectively).A larger FAZ perimeter(Spearman’s r=-0.524)and a lower deep perifoveal VD preoperatively(Pearson’s r=0.486)were associated with lower healing stage.CONCLUSION:The status of the deep vasculature may be an indicator of visual acuity in patients with a closed MH.Except for the deep perifoveal region,VD recovers only to preoperative levels.

Management of chronic dacryocystitis cases after failed external dacryocystorhinostomy using endoscopic technique with a novel lacrimal ostium stent

AIM: To demonstrate the outcomes of endoscopic endonasal dacryocystorhinostomy(En-DCR) with an novel lacrimal ostium stent(LOS) which was performed in patients with recurrent epiphora after failed external dacryocystorhinostomy(Ex-DCR) and analyze the causes of failed Ex-DCR.METHODS: From September 2015 and December 2017, the clinic data of 29 cases suffered from recurrent epiphora after failed Ex-DCR was reviewed.The LOS were implanted into the ostium at the end of the revisional surgery.The causes of failed Ex-DCR were analyzed before revisional surgeries.Outcome of revisional surgeries with the new device were evaluated as well.RESULTS: The major causes of failure of the external approach were synechiae formation in the nasal ostium(29/29), followed by inadequate removal of the bony wall(21/29), nasal synechiae formation between lateral wall of nose and middle turbinate(11/29), and the bone opening was not in good location(7/29).The rate of success after revisional surgery was 82.76%.Re-obstruction of the ostiums were found in 5 failed cases.CONCLUSION: Endoscopic approach with a novel LOS may be an effective procedure to manage recurrent epiphora after previous failed Ex-DCR surgery.Synechiae formation in the nasal ostium and inadequate removal of the bony wall were the major causes of failure of Ex-DCR.

Feasibility and utility of intraoperative optical coherence tomography during vitreoretinal surgery:A 4-year report in Chinese population

The objective is to introduce the application of intraoperative optical coherence tomography(iOCT)in pars plana vitrectomy(PPV)for various vitreoretinal diseases,and to report the 4-year assessment of feasibility and utility in Chinese population.We reported a retrospective case series of patients who underwent PPV and iOCT scan at Eye Hospital of Wenzhou Medical University from January 2016 to January 2020.Clinical characteristics were documented before operation,and we intraoperatively recorded the time and results of iOCT scanning,specific surgical maneuvers performed,the consistency with the planned strategies before surgery,the type of OCT images obtained,and adverse events(AEs).The surgeon feedback was collected to evaluate the utility of iOCT during surgery.In total 339 eyes successfully completed iOCT scan,with an average scanning time of 3.54±2.3 min,including 59 cases of idiopathic macular hole(iMH),134 cases of idiopathic epiretinal membrane(iERM),33 cases of lamellar macular hole(LMH),40 cases of high myopic maculopathy,13 cases of vitreous macular traction(VMT),60 cases of dense vitreous hemorrhage(VH).The iOCT findings were not consistent with exami-nation under the operating microscope in 49 cases(14.5%),including 29 cases(8.6%)which changed the operation strategies during surgery.The Hole-door phenomenon arose in 20 cases(33.9%)of iMH and 3 cases(25%)of high myopic MH after ILMs peeling.Moreover,the residue ERM was observed in nine cases(6.7%)of iERM and two cases(14.3%)in high myopic ERM after ILMs peeling.Some new surgical methods could also be confirmed using iOCT.The ap-plication of iOCT has a significant clinical functionality in vitreoretinal surgery,providing the surgeon with a new surgical understanding,guiding the selection of a more reasonable operative procedure during surgery,predicting postoperative recovery and improving postoperative outcomes.

Accuracy of optimized Sirius ray-tracing method in intraocular lens power calculation

AIM:To evaluate the accuracy and predictability of ray tracing-assisted intraocular lens(IOL) calculation function in Sirius internal software and further improve the accuracy by optimizing the calculation of predicted lens position(PLP).METHODS:This retrospective study recruited 52 eyes of 49 patients.All of the cases with cataract had undergone phacoemulsification combined with IOL implantation.SRK-T,Haigis formula,and Sirius ray-tracing method were all used for each eye’s IOL calculation.The mean absolute value of prediction error(prediction error=predicted refraction-postoperative refraction) was defined as mean absolute prediction error(MAPE) and was determined for each method.Calculation of PLP was optimized by effective lens position(ELP).Optimized PLP was entered to Sirius internal software again to verify whether the method was improved.RESULTS:Compared with SRK-T and Haigis formulas,less accuracy was shown in Sirius ray-tracing method(P=0.001).The ELP of the IOL moved forward compared to PLP(P<0.001).The MAPE of the ELP-inputted Sirius ray-tracing method was reduced.ELP and PLP were well correlated.Taking ELP as y and PLP given by Sirius soft as x,a linear regression formula y=0.1637 x+3.1741 was concluded(R^(2)=0.1066,P=0.018).It was shown that the optimized Sirius ray-tracing method(optimized PLP entered),compared with SRK-T and Haigis formulas,worked with the same accuracy(P=0.038).CONCLUSION:The original Sirius ray tracing method is not satisfactory enough.However,in normal eyes,the optimized Sirius ray-tracing method in IOL calculation was as accurate as SRK-T and Haigis formulas.

New technique for removal of perfluorocarbon liquid related sticky silicone oil and literature review

AIM:To investigate the safety and efficacy of sticky silicone oil(SSO)removal using a 22-gauge vein detained needle and inner limiting membrane(ILM)wrap-and-peel technique.METHODS:This retrospective consecutive case series reviewed the records of patients with a history of retinal detachment who had received silicone oil and perfluorocarbon liquid(PFCL)as intraocular tamponades.Patients were included in the analysis if they exhibited SSO remnants during silicone oil removal.The aspiration of most of the SSO remnants was performed by a 22-gauge vein detained needle.The small amounts of droplets adhered to the macula and epi-macular membrane were subsequently removed by the ILM warp-and-peel technique.The anatomical and functional outcomes,and postoperative complications were recorded.In vitro experiments were performed to simulate the formation of SSO remnants in four groups.RESULTS:Of 711 patients who underwent silicone oil removal during the study period,9 patients exhibited SSO remnants and underwent follow-up for at least 3mo.Seven eyes(78%)underwent the ILM wrap-and-peel technique to completely remove small droplets of SSO that were glued to the macula and epi-macular membrane.No obvious complications occurred.Postoperative optical coherence tomography revealed normal retinal structure in all patients.In vitro analyses showed that balanced salt solution and prolonged vibration(for 1wk)had the strongest effects on silicone oil and PFCL compound opacities.CONCLUSION:SSO remnants could be removed in an intact manner and without complications,using a vein detained needle-assisted and ILM wrap-and-peel technique.The findings suggest that PFCL and infusion fluid should be completely removed before silicone oil injection to prevent SSO formation.